Digestive Endocrinology and Glucose Metabolism Flashcards
Alpha cells
Glucagon
Beta cells
Insulin
Delta cells
Somatostatin
T or F: The pancreas is retro-peritoneal
True
2nd lumbar vertebral level
Endocrine pancreas
Accounts for 2% of pancreatic mass
Islets of langerhans
Glucagon
Produce increase in blood glucose Breakdown of glycogen Stimulates gluconeogenesis Make fatty acids available for energy Released in response to low glucose levels, high AA concentration and exercise
Insulin
Lowers blood glucose
Promotes uptake of glucose by target cells
prevents fat and glycogen breakdown
Promotes fat storage
Which circulation does insulin enter?
Portal circulation
How is insulin release regulated?
Glucose enters cells and becomes glucokinase, resulting in closure of K and opening of Ca channels resulting in exocytosis of insulin.
Acinar cells secrete?
digestive enzymes
What do the hepatic duct and pancreatic duct secrete through into the duodenum?
Papilla of Vater which is surrounded by the sphincter of Odi.
Darth Vater and Odi one kanobi
Hypoglycemia early signs
Sweating/palpitations/tremor nervousness/irritability parasthesias Hunger N/V
Hypoglycemia late signs
HA, tired, drowsy Dizzy/syncope Blurred vision, confusion abnormal behavior Seizures, Coma
Whipples triad
- Group of symptoms associated with hypoglycemia.
- Low plasma glucose (<55)
- relief of symptoms by raising glucose
Reactive hypoglycemia
Severe exercise Medication use -insulin, Beta blockers -bactrim -haloperidol -MOA inhibitors
Functional Hypoglycemia
Hepatic and renal dysfxn Malnutrition Endocrinopathies -adrenal insufficiency -GH deficiency -glucagon insuficiency Pancreatic tumors Alcohol consumption
Neuroglycopenic Presentation
Usually a result of fasting hypoglycemia
Result from decreased glucose supply to CNS and PNS.
HA, confusion, slurring speech, coma, seizures, neuromuscular sx.
Andregenic Presentation
Caused by abrupt decrease in glucose level
Release of epi
Hunger, diaphoresis, weakness, palpitation
Diabetic Ketoacidosis
Insulin deficiency, hyperglycemia Blood glucose >250, ketones, acidosis Most commonly seen in type 1 Can also happen in type 2 Onset of hours to days
DKA leads to…
Dehydration Increased osmolarity (<320) Increased serum amylase Elevated white count Hypertriglyceridemia
DKA causes
Infection
New onset diabetes
Insulin administration
Stress
DKA Symptoms
N/V
Polyuria, polydypsia
Abd pain
weakness/fatigue/anorexia
DKA signs
Tachycardia Hypotension poor skin turgor dry skin/mucous membranes Kussmaul respirations Hypothermia Fruity breath AMS, coma
T of F: DKA causes hyperosmolarity.
True
Osmotic diuresis leads to dehydration
Decrease in serum bicard = acidosis
Breakdown of fatty acids for energy leads to production of?
Ketones
Hypertriglyceridemia
DKA tx
NS 1L/hr x 2 hrs
Watch Na: replace if needed
When glucose is <250, switch to dextrose .05%
DKA insulin therapy
10U IV bolus
Drip 6U/hr
Dont decrease glucose level too fast
check blood sugar hourly
Once DKA patients can eat and drink, change insulin to from IV to….
SQ
Hyperglycemic Hyperosmolar Nonketotic Syndrome
Occurs exclusively in type 2 Elderly, physically impaired Limited access to free water High (>600) hyperglycemia absence of acidosis Greater dehydration
